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General NPI Number Information
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NPI Number | 1376372243
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Entity Type | Organization
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Legal Business Name | CHARTERCARE ROGER WILLIAMS MEDICAL CENTER
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Dates
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Enumeration Date | 07/30/2024
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 825 CHALKSTONE AVE
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City | PROVIDENCE
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State | RI
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Zip | 02908-4728
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Country | US
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Telephone | 401-456-2000
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Fax | 401-456-2029
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Provider Business Mailing Address
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Address Line | 825 CHALKSTONE AVE
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City | PROVIDENCE
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State | RI
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Zip | 02908-4728
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Country | US
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Telephone | 401-456-2000
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Fax | 401-456-2029
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Authorized Official
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Title or Position | CEO
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Name | JEFFREY LIEBMAN
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Credential |
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Telephone | 401-456-2001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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